304 TREATMENT OF SPECIFIC ANXIETY DISORDERS
recovered patients or healthy controls experienced a panic attack after reading word
pair associates consisting of bodily sensations and catastrophes (e.g., palpitations-dying;
nausea- numbness). In their cardiac monitoring study of panic disorder, Pauli et al. (1991)
found that anxiety elicited by cardiac perceptions led to an increase in patients’ heart
rate during the period immediately after the cardiac perception. In another study involv-
ing a panic disorder sample, scores on the ASI Physical subscales predicted subjective
fear during a hyperventilation challenge (Brown et al., 2003). Although these studies
provide only indirect support, there is sufficient evidence to encourage further research
that bodily sensations are experienced more intensely after catastrophic misinterpreta-
tions.
Hypothesis 5. Dissociation
Individuals with panic disorder will exhibit diminished ability to employ higher order
ref lective thinking to generate more realistic and benign interpretations of their fearful
internal sensations compared with individuals without panic disorder.
A critical difference between a catastrophic misinterpretation model of panic and
the cognitive model of panic proposed by Beck (1988) is the central role that dissocia-
tion of higher order reflective thinking plays in the pathogenesis of the anxiety attack.
Beck stated: “The next state which is crucial to the experience of panic, as contrasted
to simple severe anxiety, is the loss of the capacity to appraise the symptoms realisti-
cally, which is associated with the fixation on the symptoms” (1988, p. 94). Thus panic
attacks occur because the individual with panic disorder is unable to retrieve a more
realistic explanation for the sensations that counters the catastrophic misinterpretation.
Unfortunately this aspect of the cognitive model has generated little research attention
as most of the focus has been on the role of catastrophic misinterpretations of bodily
sensations.
In a questionnaire study comparing individuals with panic disorder and nonclinical
groups, Kamieniecki et al. (1997) found that individuals with panic disorder provided
significantly more anxious interpretations of ambiguous internal scenarios which were
not followed by benign alternative explanations for the elevated physical sensations
described in the scenario. The authors conclude that the panic disorder patients were
unable to reinterpret their physical state in an innocuous manner. Wenzel et al. (2005)
reported that individuals successfully treated for panic disorder scored higher on items
that reflected an ability to reason about and evaluate their anxious thoughts and symp-
toms more realistically than individuals who still experienced difficulties with panic.
There is also evidence that providing a more benign explanation for experimentally
induced physical sensations or safety information can reduce anxiety and increase a feel-
ing of safety (Rachman & Levitt, 1985; Rachman, Levitt, & Lopatka, 1988; Schmidt,
Richey, Wollaway- Bickel, & Maner, 2006). If a feeling of safety is a critical factor in
the offset or termination of a panic episode (Lohr, Olatunji, & Sawchuk, 2007; Rapee,
1995a), then generating a corrective interpretation of physical arousal might be an
important factor in engendering safe feelings. The inability to self- correct catastrophic
misinterpretations would be a major obstacle to acquiring safe feelings. At the very least
these preliminary findings suggest that further investigation of the dissociation of auto-